Archive for Mental Health
Orthorexia: Where Eating Disorders Meet OCD – Part 2
Effective Strategies and Predictable Complications in the Treatment of Orthorexia
In our previous article about Orthorexia, we described this relatively unknown and misunderstood condition. In this, the second and final installment in this series, we discuss strategies and pitfalls in the treatment of Orthorexia.
Orthorexia can be effectively treated with Cognitive Behavioral Therapy (CBT) and Mindfulness
Orthorexia, being a somewhat new conceptualization of a psychological disorder, is under-researched and often misunderstood within the mental health and medical communities. Many mental health professionals have found success treating individuals with Orthorexia using evidence-based treatment methods that are used to treat other Eating Disorders, OCD, and related OC Spectrum Disorders.
Cognitive-Behavioral Therapy (CBT) and Mindfulness are two highly effective treatment methods used to treat Orthorexia. Using CBT, individuals with Orthorexia learn to challenge and change their distorted thoughts (cognitions) related to their body and the foods they eat. Education about nutrition and what is considered “healthy” should also be integrated into CBT when treating Orthorexia, using logical, evidence-based strategies. › Continue reading
The ABC’s of Dermatillomania / Compulsive Skin Picking
Not all skin picking is the same.
Everybody picks their skin sometimes, right? If you tell your friends or family that you pick your skin, many of them might say “Oh, I do that, too”. So, how do you know if your skin picking is severe enough to warrant a diagnosis of Dermatillomania, also known as Compulsive Skin Picking or Chronic Skin Picking (CSP)?
There are a variety of ways in which assessment of skin picking occurs. Self-assessment might occur by the person doing the skin picking when an individual realizes that he or she is causing scabs, scars, and/or infections. A person with Dermatillomania may also be aware that he or she is avoiding social situations, including work, school, and/or social functions such as weddings and parties. After all, those who have picked to the point of bleeding and scabbing may be too embarrassed to be seen by others who might judge them or ask questions about their skin. › Continue reading
Sexual Orientation OCD – Part 4: Challenges to Treatment of HOCD
Jon Hershfield, MA, of the OCD Center of Los Angeles discusses common challenges seen in the treatment of Sexual Orientation OCD, also known as HOCD or Gay OCD. Part four of a four-part series.
Sexual Orientation OCD - also known as HOCD or Gay OCD - is best treated with Cognitive Behavioral Therapy
In my previous blog on Sexual Orientation OCD (aka HOCD), I looked at some of the potential sub-types that appear in this condition. While they are all treated with various Cognitive Behavioral Therapy (CBT) strategies, crippling fear can lead people toward beliefs that impede therapy. Here are some thoughts about treatment issues I commonly hear from HOCD clients.
My Big Gay Secret Self
Many HOCD sufferers, regardless of sub-type, become preoccupied with the idea that other people might think that they somehow “appear” gay. As a result, some men with HOCD may over-attend to the way they dress, opting for baggy, neutral choices rather than fitting, stylish choices that they might associate with homosexuality. They may pay special attention to the way they speak or even the way they hold a drink, trying to eradicate any possibility that a person may mistake them for being gay. Women with HOCD may over-attend to the length of their hair, or whether their clothes are “feminine” enough. Both men and women with HOCD are likely to obsess about their body type and whether there is something inherently “gay” about it. › Continue reading
OCD and Thought Suppression
Thought suppression is a common feature of OCD, especially for those with Pure Obsessional OCD (sometimes called "Pure O")
Over the last few weeks, I have had a secret. For most people, this secret would not have been seen as important, but to me it was. Every time I had these thoughts I became overwhelmed with anxiety, fear and an almost palpable sense of terror. As soon as the thought of this secret flashed through my mind, I would have visions that would take me to its worst-case outcome. As I played these thoughts out in my head, I physically experienced extreme anxiety, as if the discovery of my secret was actually happening.
Just a few days ago, I was on the treadmill and the thought flashed through my mind again. I was immediately plagued with heightened anxiety. Even the lady on the treadmill next to me noticed and commented that my face had a strange look on it. In response to the thought, I did what most people would do. I tried not to think about it.
At that point, I started a conversation with the lady next to me…and the thought popped up in my head. After the conversation was over, I read a trashy magazine… and the thought popped up in my head again. I then began running as fast as I could, dripping with sweat and breathing deeply, and the thought still managed to surface. Actually, not only did it surface, but it continued to inflate in my head, as if it was going to soon explode. › Continue reading
Sexual Orientation OCD: HOCD Sub-Types and Their Treatment
Jon Hershfield of the OCD Center of Los Angeles discusses treatment of Sexual Orientation OCD, also known as HOCD or Gay OCD, using Cognitive Behavioral Therapy (CBT) and Mindfulness. Part three of an ongoing series.
There are many variations and sub-types of Sexual Orientation OCD (HOCD)
When I initially wrote the part one and part two of my article on Sexual Orientation OCD (aka “Homosexual OCD”, aka “HOCD”, aka “Gay OCD”), it was intended solely to reflect this rather common form of the disorder as I saw it presented in several of my clients. I had not anticipated such a significant online response, with so many additional questions and angles on the subject.
Sexual obsessions in general are under-reported because of shameful feelings associated with them. And yet there is probably a somewhat higher prevalence of sexual obsessions in OCD than any other obsession for this same reason – the thoughts are unwanted! This seems so very evident in Sexual Orientation OCD because the feared consequence appears so tangible. In other common OCD obsessions, such as “Harm OCD”, the idea that someone might be in denial of violent impulses is plenty terrifying. However, there is an understanding that being violent is unacceptable in and of itself. With Sexual Orientation OCD, the sufferer generally does not see anything wrong with being gay per se, as long as it is not themselves being gay. This causes a lot of confusion and a lot of resistance to seeking treatment. › Continue reading
Social Anxiety / Social Phobia: Alone With Witnesses – Part 2
In part one of this two-part series, we discussed the experience of the Social Anxiety sufferer. In part two, we examine how to treat this condition with Cognitive Behavioral Therapy (CBT), and how Social Anxiety relates to other Obsessive Compulsive Spectrum Disorders.
Treatment of Social Anxiety
Social Anxiety can be successfully treated with Cognitive Behavioral Therapy (CBT)
The most effective form of treatment for Social Anxiety is the same as in other Obsessive Compulsive Spectrum Disorders – Cognitive Behavioral Therapy (CBT). This is because, like the other disorders in the spectrum, Social Anxiety involves an obsession and a series of compulsions which form a cycle.
The fundamental obsession in Social Anxiety is the fear of being evaluated negatively. This generally includes fears of being rejected, as well as the fear of being singled out for humiliation and traumatized by emotional abuse from others. The primary compulsion in Social Anxiety is the phobic avoidance of social situations in which one fears rejection and/or humiliation (thus its synonym, Social Phobia).
It is tempting to look at avoidance as the absence of engaging in social behavior. However, avoidance is an overt physical and mental behavior, the primary goal of which is to reduce or eliminate anxiety. For the individual with Social Anxiety, the act of choosing not to go to the party thus serves the same function as the act of choosing to wash one’s hands serves for the individual with OCD. Further, those with Social Anxiety who are able to commit to a social interaction may find themselves escaping mentally in the process by spending their energy focusing on things other than the present situation. › Continue reading
Social Anxiety / Social Phobia: Alone With Witnesses – Part 1
Many people mistakenly think of Social Anxiety as nothing more than shyness. In this two-part series, Jon Hershfield of the OCD Center of Los Angeles discusses Social Anxiety, its treatment with Cognitive Behavioral Therapy (CBT), and its relationship to other OC Spectrum Disorders.
Social Anxiety, also known as Social Phobia, is more than just shyness.
When I first began treating people with Social Anxiety Disorder (also known as Social Phobia), it seemed to me that this condition was primarily a problem of interesting people not realizing that they are interesting. While this is a significant element of the disorder, there is more going on than one might initially expect.
In reality, Social Anxiety and Social Phobia are terms used to describe a cluster of symptoms that center around the fear of being negatively evaluated by others. This is often confused with being shy or introverted, or even schizoid. An introvert may genuinely prefer the quiet solitude of turning inwards to the self rather than outwards to other people, while someone with schizoid personality disorder may simply not find the presence of other people to be pleasing. In either of these cases, the experience of isolation from others is essentially rooted in ego-syntonic thoughts, which simply means that the thoughts are consistent with the individual’s true beliefs and values. In other words, those who are truly introverted or schizoid genuinely prefer to be alone.
Conversely, a person suffering from Social Anxiety is burdened by unwanted intrusive thoughts about being judged, rejected, and/or and humiliated by others. › Continue reading
Binge Eating Disorder / Compulsive Overeating and Its Treatment
Binge Eating / Compulsive Overeating is a real problem that can be successfully treated
Binge Eating Disorder, also known as ‘”compulsive overeating”, can perhaps best be described as a condition in which one periodically consumes extremely large amounts of food. Individuals with Binge Eating Disorder have a strong motivational drive for food and experience great difficulty in their attempts to restrain their eating. They frequently continue eating well beyond their satiation level, with many reporting that their behavior feels “unconscious”, and that they have little control over it. It appears that compulsive overeating is often done in response to emotional difficulties or psychosocial stressors. Unfortunately, during and after a binge, one is often left feeling more depressed, anxious and helpless than they did before they overate.
In addition to the psychological issues noted above, some researchers and theoreticians believe that compulsive overeating has played a significant role in the dramatic increase in obesity levels in the Untied States over the past 30 years. Obesity is commonly identified as having a body-mass index (BMI) over 30. Using this guideline, approximately 34% of Americans are currently classified as obese, compared to 15% in 1980. During this same 30 year period, this increase in obesity has led to a concomitant surge in diabetes and hypertension, both of which are risk-factors for heart disease, the number one cause of death in the US. › Continue reading
Sexual Orientation OCD, aka HOCD / Gay OCD – Part 2
Jon Hershfield of the OCD Center of Los Angeles discusses treatment of Sexual Orientation OCD, also known as HOCD or Gay OCD, using Cognitive Behavioral Therapy (CBT) and Mindfulness. Part two of an ongoing series.
Treatment of Sexual Orientation OCD
Sexual Orientation OCD can be successfully treated with Cognitive Behavioral Therapy and Mindfulness
As noted in our previous post, Sexual Orientation OCD is a condition in which an individual, straight or gay, obsessively doubts their sexual orientation. Research has consistently found that the most effective treatment for this and all types of Obsessive Compulsive Disorder (OCD) is Cognitive Behavioral Therapy (CBT), with a focus on Exposure and Response Prevention (ERP).
Over the past ten years, many OCD specialists have also begun to integrate concepts from Mindfulness-Based Cognitive Behavioral Therapy (MBCBT) into their treatment of OCD. In MBCBT, the goal is to change one’s perspective toward one’s thoughts, as well as the behavioral responses these thoughts lead to. Using mindfulness, it is possible to circumvent much of the OCD process and ultimately reverse it into remission.
Mindfulness is particularly helpful when treating the more obsessional variants of OCD, including Sexual Orientation OCD. When combining MBCBT with the traditional tools of Cognitive Behavioral Therapy, the following treatment techniques are used to address the unwanted thoughts and behaviors seen in Sexual Orientation OCD. › Continue reading
Sexual Orientation OCD, aka HOCD / Gay OCD – Part 1
Many people mistakenly think of Obsessive Compulsive Disorder (OCD) solely as a condition in which people wash their hands excessively or check door locks repeatedly. There are actually many sub-types of OCD. In this ongoing series, Jon Hershfield of the OCD Center of Los Angeles discusses Sexual Orientation OCD, also known as HOCD or Gay OCD.
So, Am I Gay or What?
I sat down to write this blog on Sexual Orientation OCD while my wife and I had started to watch a movie (It’s been suggested I work too much). It’s either irony or personalization, but the opening scene of the movie involves a man kissing his lover… another man. This is the second film in two weeks that I’ve rented which involve men and their male lovers, something I was not aware of when I selected the films.
Or was I?
Sexual orientation OCD is sometimes referred to as HOCD (an abbreviation for Homosexual Obsessive Compulsive Disorder) or Gay OCD. › Continue reading
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